Provider Demographics
NPI:1740586155
Name:OYETUNBI, SOPHIA OLAITAN (ASAP COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:SOPHIA
Middle Name:OLAITAN
Last Name:OYETUNBI
Suffix:
Gender:F
Credentials:ASAP COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 WILSON ST.
Mailing Address - Street 2:
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-9042
Mailing Address - Country:US
Mailing Address - Phone:580-558-2134
Mailing Address - Fax:580-558-2314
Practice Address - Street 1:4301 WILSON STREET
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-9042
Practice Address - Country:US
Practice Address - Phone:580-558-2134
Practice Address - Fax:580-558-2314
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1078101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)